Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) Trial.

Abstract

BACKGROUND:

In 10,001 patients with stable coronary artery disease (CAD) enrolled in the Treating to New Targets (TNT) trial, 80 mg/d of atorvastatin (high-dose regimen) reduced the composite primary end point of death from CAD, nonfatal myocardial infarction, resuscitation from cardiac arrest, or stroke by 22% relative to 10 mg/d (low-dose regimen).

METHODS:

We performed an economic analysis of this trial from the US perspective using hospital bills and Medicare physician fees to estimate costs for cardiovascular hospitalizations in all US patients (n = 5,308). Atorvastatin costs were assigned using a discounted average wholesale price. Cost-effectiveness was calculated as the within-trial incremental cost required to prevent one primary end point event with high-dose atorvastatin.

RESULTS:

During a mean 4.9-year follow-up, the high-dose arm had fewer potential end point cardiovascular hospitalizations (35% vs 41%, P < .001) and revascularization procedures (16% vs 22%, P < .001). The high-dose regimen was $1 per day more expensive. At the end of 5 years, cumulative incremental cost for the high-dose arm was $252 (95% CI-$722 to +$1,276). With an absolute reduction in the primary end point of 2.8 per 100 treated with the high-dose regimen, the cost to prevent one additional primary end point event was $8,964.

CONCLUSION:

High-dose atorvastatin treatment of 5 years had only a small net incremental cost because of reduced complications and procedures. The cost to prevent one additional primary end point event with high-dose therapy was similar to that for drug-eluting stents versus bare metal stents in stable CAD and for early invasive versus early conservative therapy in acute coronary syndromes.

• Authors: Daniel B Mark, J David Knight, Patricia A Cowper, Linda Davidson-Ray, Kevin J Anstrom
• Journal: American heart journal (Am Heart J) Vol. 156 Issue 4 Pg. 698-705 (Oct 2008) ISSN: 1097-6744 [Electronic] United States
• PMID: 18926150 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Heptanoic Acids
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Pyrroles
• Atorvastatin

Topics

• Aged
• Atorvastatin
• Coronary Artery Disease (drug therapy, economics, therapy)
• Female
• Heptanoic Acids (administration & dosage, economics)
• Hospital Costs
• Hospitalization (economics)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (administration & dosage, economics)
• Male
• Medicare (economics)
• Middle Aged
• Myocardial Revascularization (economics, statistics & numerical data)
• Outcome Assessment, Health Care
• Prospective Studies
• Pyrroles (administration & dosage, economics)
• United States